The Patient Flow Management Center at Thomas Jefferson University Hospital in Philadelphia was created in response to increased diversion hours in the ED, an increased left-without-being-seen rate in the ED and concerns about patient satisfaction.
Since its opening in 2011, administration and staff have seen an 80% reduction in ED diversion hours, a 50% reduction in the ED left-without-being-seen rate and a 50% reduction in environmental services turnaround times.
The center’s 25-member operations team includes staff from bed management; environmental services; the transfer center; patient transport department; JeffSTAT, the facility’s air and ground transport service; and case management.
The center serves three Jefferson Health System Hospitals: Thomas Jefferson, Methodist Hospital and Jefferson Hospital. That translates to a total of 957 hospital beds.
“Using GE performance excellence methodologies and engaging frontline nurses, physicians, case managers, housekeepers and other disciplines to assess current practices, barriers, possible solutions and prioritization of these solutions, we discovered a huge opportunity to improve communication and increase coordination between departments. We developed our center to expedite the admission and discharge process,” said Brian Sweeney, RN, MBA, FACHE, vice president, clinical and support services.Holly Meisner, RN
An important step was moving staff with a role in patient flow into a common office to eliminate delays associated with exchanging information via phone, fax, email or other information systems.
Face the challenges
Patient Flow Clinical Supervisors Ann Marie Desmond, RN, BSN, and Adam Skinner, RN, BSN, work with nurses on the units, physicians, patient flow coordinators and other PFMC members in placing patients in appropriate hospital beds.
“We are responsible for triaging patients who have been transferred from other facilities, patients who need transfers from within and those who are being admitted from the ED or from MD offices,” Desmond said.Above: Erin Grange, RN, patient flow supervisor, works with nurses on the units, physicians, patient flow coordinators and the other PFMC members in placing patients in appropriate hospital beds in a timely manner. • Below: From left, RNs Brian Sweeney, vice president, clinical and support services; Ann Marie Desmond, patient flow clinical supervisor; and Adam Skinner, patient flow clinical supervisor, have seen a significant reduction in ED diversion hours, the ED left-without-being-seen rate and in environmental services turnaround times as a result of the PFMC at Jefferson.
Because the clinical supervisors are present at rapid-response team events, they can determine, along with nurses and physicians, where a patient must go after the event, depending on that patient’s condition.
“We also spend time on the units, discussing issues with staff and speaking with patients who have been delayed in a transfer, so they know we are working with them,” Skinner said.
The PFMC staff uses an integrated technology platform of TeleTrackingXT Capacity Management Suite to manage hospital operations. They also monitor other key hospital information systems, such as Wellsoft, the ED’s electronic medical record, to monitor patient arrivals and plan for bed availability.
Because the OR schedule is more predictable, the PFMC staff looks at OR bed needs 24 hours in advance. However, emergent transfers and admissions from physicians’ offices can change bed demands in a short period of time.Photo by Janice Petrella Lynch, RN, MSN
A patient flow clinical supervisor in the PFMC, Adam Skinner, RN, is present at rapid-response team events and spends time on the units to work with staff on patient flow issues.
“We have refined our entire admission and transfer process to improve service to patients and our physicians,” Sweeney said. “We have more opportunities to improve our discharge process, including length of stay management.”
With rehab facilities narrowing the time frame in which they will admit patients in a day and with discharged patients waiting to be picked up by family members, administration and staff are identifying more creative solutions to ensure timely discharge.
Solutions that work
At weekly PFMC operations meetings, an interdisciplinary team reviews patient flow metrics and identifies any concerns or issues.
“We look at patient flow metrics for pull-ins, room cleaning, transport, bed assignments, just to name a few, and from there we can make any necessary improvements, whether it be through staff education, improved communication or a change in the system,” said Karen Montoro, RN, BSN, NE-BC, nurse manager, med-surg, gyn and oncology. “For example, as a result of discussion at one of our nursing council meetings, a direct number was identified to be used by the nursing units to contact the ED to facilitate communication.”Photo courtesy of Thomas Jefferson University Hospital
At a bed management meeting in the PFMC conference are, from left, Mary Vergara, RN, staffing coordinator; Diana Marshall, RN, patient flow clinical supervisor; Melissa Yarnes, patient flow coordinator; Holly Meisner, RN, bed management director; Frank Rocco RN, ED manager; Kevin Green, environmental services supervisor; Ann Marie Desmond, RN, patient flow clinical supervisor; Rose Moceri, RN, clinical charge nurse, PACU; Kathlyn Davis, RN, case management coordinator; and Duane Spencer, director of JeffSTAT and the transfer center.
A discharge hotline went live in the fall for the purpose of providing real-time assistance and resolving barrriers to timely discharge.
Any member of the team can use the 24/7 hotline, but calls to the hotline generally are made by physicians and nurses. A patient flow case manager covers the line during the day, and the PFMC staff responds to any calls in the evenings, at night or on weekends.
“The case manager or PFMC staff try to resolve identified barriers to discharge by working with ancillary departments to get an MRI or other study completed, to obtain medications from the pharmacy or to arrange transportation for a patient,” said Mary O’Brien, RN, CCM, manager, case management.
To date, the hotline has received 55 calls, and data reveal a savings of 22 patient days.
Interdepartmental bed meetings are conducted three times a day to help improve the coordination of transfers between hospital units, such as the ICUs and telemetry units; to identify beds that might be blocked for maintenance or infection control precautions; and to develop action plans when the census is high.
“By communicating with one another every day about our action plans, we make a difference in the delivery of care, patient satisfaction, our patients’ length of stay and their timely discharge,” said Holly Meisner, RN, BSN, director, bed management. “There are so many people involved in our patients’ care, and keeping the patient at the center of our focus is key to our success.”
Janice Petrella Lynch, RN, MSN, is a regional reporter.
SEE PHOTOS of the PFMC at Jefferson, visit Nurse.com/galleries.